[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[S. 1031 Introduced in Senate (IS)]
<DOC>
118th CONGRESS
1st Session
S. 1031
To ensure affordable abortion coverage and care for every person, and
for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 29, 2023
Ms. Duckworth (for herself, Mrs. Murray, Ms. Hirono, Mr. Merkley, Ms.
Warren, Mr. Padilla, Mr. Whitehouse, Mr. Markey, Ms. Cortez Masto, Mr.
Fetterman, Mrs. Feinstein, Mr. Blumenthal, Mr. Booker, Ms. Stabenow,
Mr. Wyden, Ms. Klobuchar, Mr. Cardin, Mr. Brown, Mr. Sanders, Ms.
Baldwin, Ms. Cantwell, Ms. Smith, Mr. Murphy, Ms. Rosen, Ms. Hassan,
Mrs. Shaheen, Mr. Bennet, Mrs. Gillibrand, Mr. Van Hollen, Mr. Welch,
and Mr. Heinrich) introduced the following bill; which was read twice
and referred to the Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To ensure affordable abortion coverage and care for every person, and
for other purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Equal Access to Abortion Coverage in
Health Insurance Act of 2023'' or the ``EACH Act of 2023''.
SEC. 2. FINDINGS.
Congress makes the following findings:
(1) All people should have access to abortion services
regardless of actual or perceived race, color, ethnicity,
language, ancestry, citizenship, immigration status, sex
(including a sex stereotype; pregnancy, childbirth, or a
related medical condition; sexual orientation or gender
identity; and sex characteristics), age, disability, or sex
work status or behavior.
(2) A person's income level, wealth, or type of insurance
should not prevent them from having access to a full range of
pregnancy-related health care, including abortion services.
(3) No person should have the decision to have, or not to
have, an abortion made for them based on the ability or
inability to afford the health care service.
(4) Since 1976, the Federal Government has banned the use
of Federal funds to pay for abortion services and allows for
exceptions only in very narrow circumstances. This ban affects
people of reproductive age in the United States who are insured
through the Medicaid program, as well as individuals who
receive insurance or care through other federally funded health
programs and plans.
(5) Women make up the majority of Medicaid enrollees (54
percent) and, in 2019, approximately 14,000,000 women of
reproductive age relied on the program for care. Due to
systematic barriers and discrimination, a disproportionately
higher number of women of color and Lesbian, Gay, Bisexual,
Transgender, or Queer (LGBTQ) individuals are enrolled in the
program.
(6) Women of color are more likely to be insured by the
Medicaid program. Nationwide, 29 percent of Black women and 25
percent of Hispanic women aged 15 to 49 were enrolled in
Medicaid in 2018, compared with 15 percent of White women.
(7) In the aggregate, nearly one-fifth (19 percent) of
Asian-American and Pacific-Islander women are enrolled in the
Medicaid program, while enrollment rates for certain Asian
ethnic subgroups are much higher (at 62 percent of Bhutanese
women, 43 percent of Hmong women and 32 percent of Pakistani
women).
(8) Medicaid also provides coverage to more than 1 in 4 (27
percent) non-elderly American Indian and Alaska Native (AIAN)
adults and half of AIAN children.
(9) In a 2014 nationwide survey of LGBT people with incomes
less than 400 percent Federal Poverty Level (FPL), 61 percent
of all respondents had incomes in the Medicaid expansion
range--up to 138 percent of the FPL--including 73 percent of
African-American respondents, 67 percent of Latino respondents,
and 53 percent of White respondents. Another survey found that
32 percent of Asian and Native Hawaiian/Pacific Islander
transgender people were living in poverty.
(10) Of women aged 15 through 44 enrolled in Medicaid in
2018, 55 percent lived in the 34 States and the District of
Columbia where Medicaid does not cover abortion services except
in limited circumstances. This amounted to 7,200,000 women of
reproductive age, including 3,000,000 women living below the
FPL. Of this population, Black, Indigenous, and other People of
Color (BIPOC) women accounted for 51 percent of those enrolled.
(11) The Indian Health Service (IHS) is the federally
funded health program for American Indians and Alaska Natives.
The IHS serves a population of approximately 2,560,000 and as a
federally funded system, since 1988, it has been barred from
providing abortion services except for very limited cases.
American Indians and Alaska Natives often face higher levels of
poverty and limited access to health care for a number of
intersecting oppressions thus leaving them without recourse for
the Federal ban on abortion services.
(12) Moreover, 26 States also prohibit coverage of abortion
services in the marketplaces and 11 prohibit coverage in
private health insurance plans under the Patient Protection and
Affordable Care Act (Public Law 111-148).
(13) A recent report details how restrictions on abortion
services coverage interfere with a person's individual decision
making, with their health and well-being, with their economic
security, with their vulnerability to intimate partner
violence, and with their constitutionally protected right to a
safe and normal health care service.
(14) About 25 percent of women covered by Medicaid seeking
abortion services must carry their pregnancies to term because
they are unable to obtain funds for their care. Government-
imposed barriers to abortion services restrict people's
decisions on if, when, and how to parent, and have long-lasting
and life-altering harmful effects on the pregnant person, their
families and their communities. Those who seek and are denied
abortion services are more likely to remain in or fall into
poverty than those who access the care they need.
(15) Restrictions on abortion service coverage have a
disproportionately harmful impact on women with low incomes,
women of color, immigrant women, LGBTQ people, and young women.
Additionally, numerous State-imposed barriers make it
disparately difficult for low-income people, people of color,
immigrants, LGBTQ people, and young people to access the health
care and resources necessary to prevent unintended pregnancy or
to assure that they are able to carry healthy pregnancies to
term. Furthermore, young people of reproductive age (ages 15 to
24) are more likely to have a lower income than those older
than that, and this income gap is greater for young BIPOC. More
than 40 percent of youth and children under age 19 and almost a
quarter of young people age 19 to 25 have health insurance
through government programs. Without insurance coverage for
abortion services, young people are at greater risk of not
having the economic means to afford care outside of insurance.
Young people face disproportionate access barriers to abortion
services, including parental involvement requirement
(notification and consent) and cost, in addition to barriers to
contraception and inadequate and incomplete sexual and
sexuality education. These challenges, which are magnified for
BIPOC and queer, trans, and nonbinary youth, can cause
significant delays in access to needed care, and could
ultimately harm the life of the young person seeking abortion
services. These institutionalized barriers deny young people's
right to bodily autonomy and can force young people to
encounter an abusive parent or guardian, ignores trusted
relationships young people may have with adults other than a
parent or legal guardian, and in the case of the judicial
bypass process, may force young BIPOC to interact with a legal
system that has historically targeted and caused harm to
communities of color.
(16) These and other government-created and government-
institutionalized barriers--including the restriction on
funding for abortion services in Federal programs--exacerbate
and create poverty and racial inequality in income, wealth-
generation, and access to services.
(17) Access to health care, including abortion services,
promotes the general welfare of people living in the United
States. Singling out abortion services for funding restrictions
in health care programs otherwise designed to promote the
health and well-being of people in the United States has cost
pregnant people their lives, their livelihoods, their ability
to obtain or maintain economic security for themselves and
their families, their ability to meet their family's basic
needs, their ability to continue their education without
disruption, and their ability to break free of abusive
relationships.
(18) Like other health care and health insurance markets in
the United States, abortion services and public insurance
programs are commercial activities that affect interstate
commerce. Providers and patients travel across State lines, and
otherwise engage in interstate commerce, to provide and access
abortion services. Material goods, services, and federally
regulated medications used in abortion services circulate in
interstate commerce.
(19) Congress has the authority to enact this Act to ensure
affordable coverage of abortion services pursuant to--
(A) its powers under the necessary and proper
clause of section 8, article I of the Constitution of
the United States;
(B) its powers under the commerce clause of section
8, article I of the Constitution of the United States;
(C) its powers to tax and spend for the general
welfare under section 8, article I of the Constitution
of the United States; and
(D) its powers to enforce section 1 of the
Fourteenth Amendment under section 5 of the Fourteenth
Amendment to the Constitution of the United States.
(20) Congress has exercised these constitutional powers to
create, expand, and insure health care access for people in the
United States for decades. Pursuant to this constitutional
authority, Congress has enacted, and subsequently reauthorized,
numerous health care programs including title XVIII of the
Social Security Act (Medicare, enacted in 1965); title XIX of
the Social Security Act (Medicaid, enacted in 1965); and title
XXI of the Social Security Act (Children's Health Insurance
Program, enacted in 1997).
SEC. 3. DEFINITIONS.
For purposes of this Act:
(1) Abortion services.--The term ``abortion services''
means an abortion and any services related to, and provided in
conjunction with, an abortion, whether or not provided at the
same time or on the same day as the abortion.
(2) Health program or plan.--The term ``health program or
plan'' means the following health programs or plans that pay
the cost of, or provide, health care:
(A) The Medicaid program under title XIX of the
Social Security Act (42 U.S.C. 1396 et seq.).
(B) The Children's Health Insurance Program under
title XXI of the Social Security Act (42 U.S.C. 1397 et
seq.).
(C) The Medicare program under title XVIII of the
Social Security Act (42 U.S.C. 1395 et seq.).
(D) A medicare supplemental policy as defined in
section 1882(g)(1) of the Social Security Act (42
U.S.C. 1395ss(g)(1)).
(E) The Indian Health Service program under the
Indian Health Care Improvement Act (25 U.S.C. 1601 et
seq.).
(F) Medical care and health benefits under the
TRICARE program (as defined in section 1072(7) of title
10, United States Code).
(G) Benefits under the uniform health benefits
program for employees of the Department of Defense
assigned to a nonappropriated fund instrumentality of
the Department established under section 349 of the
National Defense Authorization Act for Fiscal Year 1995
(Public Law 103-337; 10 U.S.C. 1587 note).
(H) Benefits for veterans under chapter 17 of title
38, United States Code.
(I) Medical care for survivors and dependents of
veterans under section 1781 of title 38, United States
Code.
(J) Medical care for individuals in the care or
custody of the Department of Homeland Security pursuant
to any of section 235, 236, or 241 of the Immigration
and Nationality Act (8 U.S.C. 1225, 1226, 1231).
(K) Medical care for individuals in the care or
custody of the Department of Health and Human Services,
Office of Refugee Resettlement under section 235 of the
William Wilberforce Trafficking Victims Protection
Reauthorization Act of 2008 (8 U.S.C. 1232) or section
462 of the Homeland Security Act of 2002 (6 U.S.C.
279).
(L) Medical assistance to refugees under section
412 of the Immigration and Nationality Act (8 U.S.C.
1522).
(M) Other coverage, such as a State health benefits
risk pool, as the Secretary of Health and Human
Services, in coordination with the Secretary of the
Treasury, recognizes for purposes of section
5000A(f)(1)(E) of the Internal Revenue Code of 1986.
(N) The Federal Employees Health Benefit Plan under
chapter 89 of title 5, United States Code.
(O) Medical care for individuals under the care or
custody of the Department of Justice pursuant to
chapter 301 of title 18, United States Code.
(P) Medical care for Peace Corps volunteers under
section 5(e) of the Peace Corps Act (22 U.S.C.
2504(e)).
(Q) Other government-sponsored programs established
after the date of the enactment of this Act.
SEC. 4. ABORTION COVERAGE AND CARE REGARDLESS OF INCOME OR SOURCE OF
INSURANCE.
(a) Ensuring Abortion Coverage and Care Through the Federal
Government in Its Role as an Insurer and Employer.--Each person insured
by, enrolled in, or otherwise receiving medical care from health
programs or plans described in section 3(2) shall receive coverage of
abortion services. Health programs or plans described in section 3(2)
shall provide coverage of abortion services.
(b) Ensuring Abortion Coverage and Care Through the Federal
Government in Its Role as a Health Care Provider.--In its role as a
provider of health services, including under health programs described
in section 3(2) and health services covered by health plans described
in section 3(2), the Federal Government shall ensure access to abortion
services for individuals who are eligible to receive medical care in
its own facilities or in facilities with which it contracts to provide
medical care.
(c) Prohibiting Restrictions On Private Insurance Coverage Of
Abortion Services.--The Federal Government shall not prohibit,
restrict, or otherwise inhibit insurance coverage of abortion services
by State or local government or by private health plans.
SEC. 5. REPEAL OF SECTION 1303.
(a) In General.--Section 1303 of the Patient Protection and
Affordable Care Act (42 U.S.C. 18023) is repealed.
(b) Conforming Amendments.--
(1) Basic health plans.--Section 1331(d) of the Patient
Protection and Affordable Care Act (42 U.S.C. 18051(d)) is
amended by striking paragraph (4).
(2) Multi-state plans.--Section 1334(a) of the Patient
Protection and Affordable Care Act (Public Law 111-148) is
amended--
(A) by striking paragraph (6); and
(B) by redesignating paragraph (7) as paragraph
(6).
SEC. 6. SENSE OF CONGRESS.
It is the sense of Congress that--
(1) the Federal Government, acting in its capacity as an
insurer, employer, or health care provider, should serve as a
model for the Nation to ensure coverage of abortion services;
and
(2) restrictions on coverage of abortion services in the
private insurance market must end.
SEC. 7. RULE OF CONSTRUCTION.
Nothing in this Act shall be construed to have any effect on any
Federal, State, or local law that includes more protections for
abortion coverage or abortion services than those set forth in this
Act.
SEC. 8. RELATIONSHIP TO FEDERAL LAW.
This Act supersedes and applies to all Federal law, and the
implementation of that law, whether statutory or otherwise, and whether
adopted before or after the date of enactment of this Act and is not
subject to the Religious Freedom Restoration Act of 1993 (42 U.S.C.
2000bb et seq.).
SEC. 9. SEVERABILITY.
If any portion of this Act or the application thereof to any
person, entity, government, or circumstances is held invalid, such
invalidity shall not affect the portions or applications of this Act
which can be given effect without the invalid portion or application.
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